Research Reports - Five years prospective investigation of anterior pituitary function after traumatic brain injury

J Neurotrauma. 2013 Mar 7

Tanriverdi F, De Bellis A, Ulutabanca H, Bizzarro A, Sinisi AA, Bellastella G, Paglionico VA, Mora LD, Selcuklu A, Unluhizarci K, Casanueva FF, Kelestimur F.

Traumatic brain injury (TBI) has been recently recognized as a common cause of
pituitary dysfunction. However there are not sufficient numbers prospective
studies to understand the natural history of TBI induced hypopituitarism. The aim
was to report the results of 5 years prospective follow-up results of anterior
pituitary function in patients with mild, moderate and severe TBI. Moreover we
have prospectively investigated the associations between TBI induced
hypopituitarism and presence of anti-hypothalamus antibodies (AHA) and
anti-pituitary antibodies (APA). Twenty five patients (20 men, 5 women) were
included who were prospectively evaluated 12 months and 5 years after TBI, and 17
of them also had a 3rd year evaluation. GH deficiency is the most common
pituitary hormone deficit at 1, 3 and 5 years after TBI. Although most of the
pituitary hormone deficiencies improve over time there are substantial
percentages of pituitary hormone deficiencies at the 5th year (28 % GH, 4 % ACTH
and 4 % gonadotropin deficiencies). Pituitary dysfunction was significantly
higher in strongly AHA and APA positive (titers ≥ 1/16) patients at the 5th year.
In patients with mild and moderate TBI, ACTH and GH deficiencies may improve over
time in a considerable number of patients but, although rarely, may also worsen
over the 5 year period. However in severe TBI, ACTH and GH status of the patients
at the 1st year evaluation persisted at the 5th year. Therefore, screening the
pituitary function after TBI until 5 years is important especially in patients
with mild TBI. Moreover close strong associations between the presence of high
titers of APA and/or AHA and hypopituitarism at the 5th year were shown for the
first time.

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